CT and neuro exams legit for monitoring brain pressure build-up

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CT scans combined with neurological examinations are just as effective for monitoring pressure build-up in the brain following a head trauma as measuring intracranial pressure using a sensor inserted via catheter or screw, according to a study published Dec. 12 in the New England Journal of Medicine.

Researchers, led by Randall Chesnut, M.D., of Harborview Medical Center in Seattle, conducted a multicenter trial involving 324 patients, ages 13 and older, who suffered traumatic brain injuries and were being treated in intensive care units in Bolivia and Ecuador. Survival rates and mental functioning of the patients were examined at three- and six-month intervals after the head trauma.

The researchers found no real difference between outcomes for the two groups of patients. The mortality rate after six months for the intracranial pressure monitoring group was 39 percent, and 41 percent for the imaging/neurological exam group.

"Within this field, this is a game changer," Chesnut said, according to a University of Washington announcement. Chestnut said that he thinks the current method of pressure monitoring relies too much on readouts from the sensor, and not enough on the overall condition of the patients, which is something CT scans and neurological exams are better able to provide.

He added that the study provides evidence that multimodality monitoring should be used more frequently, which can result in more focused treatment, less unnecessary treatment, and shorter stays in the intensive care unit.

Robert Glatter, M.D., an emergency room physician at Lennox Hill Hospital in New York City not involved in the study, said in an article published in HealthDay News that the study "shows that a good clinical exam, combined with appropriate imaging really has the potential to be as good as serial measurements of intracranial pressure when you are trying to assess response to serious head trauma.

"It's too soon, however, to make a judgment about replacing the current practice with scans and exams," Glatter said. "Larger studies are essential to really confirm the findings of this study."

To learn more:
- read the New England Journal of Medicine abstract
- here's the announcement
- read the article in HealthDay News

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